Pricing Health Behavior Interventions to Promote Adoption: Lessons from the Marketing and Business Literature

The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed, whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact

Preventing Unintentional Drug Overdose in North Carolina by Advocating for Policies that Support Overdose Prevention

The main purpose of this Capstone project was to develop and promote a policy, which became the 911 Good Samaritan and Naloxone Access bill, to reduce unintentional drug overdose deaths in North Carolina (NC). The team's partner organization, North Carolina Harm Reduction Coalition (NCHRC), solicited the Capstone team's help in raising awareness about NC's overdose problem, developing a policy solution, and advocating for state-level policy change. The Capstone project increased NCHRC's capacity to advocate for the 911 Good Samaritan and Naloxone Access bill, strengthened NCHRC's relationship with the North Carolina General Assembly (NCGA) and community stakeholders, raised awareness of the problem of drug overdose, and resulted in the passage of the policy into law. In 2010, unintentional poisoning, which typically involves drugs, became the second leading cause of injury death for all ages in the United States. Between 1997 and 2001, drug overdose deaths more than doubled in NC. Opioid pain relievers (OPR) accounted for 88% of the increase in drug-related deaths. Many overdose prevention efforts have focused on the supply side, with policies dictating prescribing practice or drug abuse screening and prevention. Although these efforts can prevent an overdose from happening, overdoses will still occur even with the best prevention efforts. Achieving a broader reduction in fatal overdose requires a more targeted policy-level intervention. For this Capstone project, the team produced five deliverables. Deliverable 1 was a literature review of the impact of drug overdose in NC and a fact sheet for distribution to stakeholders. Deliverable 2 consisted of policy recommendations, based on the literature review, intended to guide legislative sponsors in drafting a bill. Deliverable 3 was a presentation to the John Locke Foundation (JLF), a policy think tank, to educate their members and elicit support for the policy. Deliverable 4 was a drug overdose prevention summit in Raleigh to raise awareness and support among various stakeholders, including legislators, for the 911 Good Samaritan and Naloxone Access bill. Lastly, Deliverable 5 included the development of educational materials to raise awareness about the new law.Master of Public Healt

Electronic nicotine delivery devices, and their impact on health and patterns of tobacco use: a systematic review protocol

Introduction E-cigarettes or electronic nicotine delivery systems (ENDS) have recently attracted considerable attention. Among some individuals there is strong debate and a polarisation of views about the public health benefits versus harms of ENDS. With little regulation, the ENDS market is evolving, and new products are introduced and marketed constantly. Rapid developments in manufacturing, marketing and consumer domains related to ENDS will warrant frequent re-evaluation, based on the state of the evolving science. The purpose of this article is to describe a protocol for an ongoing comprehensive review of the published scientific literature on ENDS. Methods and analysis We will undertake a systematic review of published empirical research literature on ENDS using the National Library of Medicine\u27s PubMed electronic database to search for relevant articles. Data from included studies will be extracted into a standardised form, tables with study details and key outcomes for each article will be created, and studies will be synthesised qualitatively. Ethics and dissemination This review synthesises published literature and presents no primary data. Therefore, no ethical approval is required for this study. Subsequent papers will provide greater detail on results, within select categories, that represent gaps in the literature base

Recommended core items to assess e-cigarette use in population-based surveys

A consistent approach using standardised items to assess e-cigarette use in both youth and adult populations will aid cross-survey and cross-national comparisons of the effect of e-cigarette (and tobacco) policies and improve our understanding of the population health impact of e-cigarette use. Focusing on adult behaviour, we propose a set of e-cigarette use items, discuss their utility and potential adaptation, and highlight e-cigarette constructs that researchers should avoid without further item development. Reliable and valid items will strengthen the emerging science and inform knowledge synthesis for policy-making. Building on informal discussions at a series of international meetings of 65 experts from 15 countries, the authors provide recommendations for assessing e-cigarette use behaviour, relative perceived harm, device type, presence of nicotine, flavours and reasons for use. We recommend items assessing eight core constructs: e-cigarette ever use, frequency of use and former daily use; relative perceived harm; device type; primary flavour preference; presence of nicotine; and primary reason for use. These items should be standardised or minimally adapted for the policy context and target population. Researchers should be prepared to update items as e-cigarette device characteristics change. A minimum set of e-cigarette items is proposed to encourage consensus around items to allow for cross-survey and cross-jurisdictional comparisons of e-cigarette use behaviour. These proposed items are a starting point. We recognise room for continued improvement, and welcome input from e-cigarette users and scientific colleagues

Cardiovascular and metabolic health is associated with functional brain connectivity in middle-aged and older adults: Results from the Human Connectome Project-Aging study

Several cardiovascular and metabolic indicators, such as cholesterol and blood pressure have been associated with altered neural and cognitive health as well as increased risk of dementia and Alzheimer\u27s disease in later life. In this cross-sectional study, we examined how an aggregate index of cardiovascular and metabolic risk factor measures was associated with correlation-based estimates of resting-state functional connectivity (FC) across a broad adult age-span (36-90+ years) from 930 volunteers in the Human Connectome Project Aging (HCP-A). Increased (i.e., worse) aggregate cardiometabolic scores were associated with reduced FC globally, with especially strong effects in insular, medial frontal, medial parietal, and superior temporal regions. Additionally, at the network-level, FC between core brain networks, such as default-mode and cingulo-opercular, as well as dorsal attention networks, showed strong effects of cardiometabolic risk. These findings highlight the lifespan impact of cardiovascular and metabolic health on whole-brain functional integrity and how these conditions may disrupt higher-order network integrity

Ageing vision and falls: a review

Background: Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. Main body of the abstract: While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. Conclusion: We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control

Internet Daters’ Body Type Preferences: Race–Ethnic and Gender Differences

Employing a United States sample of 5,810 Yahoo heterosexual internet dating profiles, this study finds race–ethnicity and gender influence body type preferences for dates, with men and whites significantly more likely than women and non-whites to have such preferences. White males are more likely than non-white men to prefer to date thin and toned women, while African-American and Latino men are significantly more likely than white men to prefer female dates with thick or large bodies. Compatible with previous research showing non-whites have greater body satisfaction and are less influenced by mainstream media than whites, our findings suggest Latinos and African Americans negotiate dominant white idealizations of thin female bodies with their own cultures’ greater acceptance of larger body types

State of the Antarctic and Southern Ocean Climate System

This paper reviews developments in our understanding of the state of the Antarctic and Southern Ocean climate and its relation to the global climate system over the last few millennia. Climate over this and earlier periods has not been stable, as evidenced by the occurrence of abrupt changes in atmospheric circulation and temperature recorded in Antarctic ice core proxies for past climate. Two of the most prominent abrupt climate change events are characterized by intensification of the circumpolar westerlies (also known as the Southern Annular Mode) between ∼6000 and 5000 years ago and since 1200–1000 years ago. Following the last of these is a period of major trans-Antarctic reorganization of atmospheric circulation and temperature between A.D. 1700 and 1850. The two earlier Antarctic abrupt climate change events appear linked to but predate by several centuries even more abrupt climate change in the North Atlantic, and the end of the more recent event is coincident with reorganization of atmospheric circulation in the North Pacific. Improved understanding of such events and of the associations between abrupt climate change events recorded in both hemispheres is critical to predicting the impact and timing of future abrupt climate change events potentially forced by anthropogenic changes in greenhouse gases and aerosols. Special attention is given to the climate of the past 200 years, which was recorded by a network of recently available shallow firn cores, and to that of the past 50 years, which was monitored by the continuous instrumental record. Significant regional climate changes have taken place in the Antarctic during the past 50 years. Atmospheric temperatures have increased markedly over the Antarctic Peninsula, linked to nearby ocean warming and intensification of the circumpolar westerlies. Glaciers are retreating on the peninsula, in Patagonia, on the sub-Antarctic islands, and in West Antarctica adjacent to the peninsula. The penetration of marine air masses has become more pronounced over parts of West Antarctica. Above the surface, the Antarctic troposphere has warmed during winter while the stratosphere has cooled year-round. The upper kilometer of the circumpolar Southern Ocean has warmed, Antarctic Bottom Water across a wide sector off East Antarctica has freshened, and the densest bottom water in the Weddell Sea has warmed. In contrast to these regional climate changes, over most of Antarctica, near-surface temperature and snowfall have not increased significantly during at least the past 50 years, and proxy data suggest that the atmospheric circulation over the interior has remained in a similar state for at least the past 200 years. Furthermore, the total sea ice cover around Antarctica has exhibited no significant overall change since reliable satellite monitoring began in the late 1970s, despite large but compensating regional changes. The inhomogeneity of Antarctic climate in space and time implies that recent Antarctic climate changes are due on the one hand to a combination of strong multidecadal variability and anthropogenic effects and, as demonstrated by the paleoclimate record, on the other hand to multidecadal to millennial scale and longer natural variability forced through changes in orbital insolation, greenhouse gases, solar variability, ice dynamics, and aerosols. Model projections suggest that over the 21st century the Antarctic interior will warm by 3.4° ± 1°C, and sea ice extent will decrease by ∼30%. Ice sheet models are not yet adequate enough to answer pressing questions about the effect of projected warming on mass balance and sea level. Considering the potentially major impacts of a warming climate on Antarctica, vigorous efforts are needed to better understand all aspects of the highly coupled Antarctic climate system as well as its influence on the Earth\u27s climate and oceans

Rural Health Professions (RHP): Development and initial assessment of an interprofessional education program

Purpose: Describe the development and integration of an interprofessional Rural Health Professions (RHP) Program. Discuss the initiation and innovative features of this unique program: history, curriculum, assessment and preliminary results. Background: Nearly all disciplines have emphasized interprofessional education as a critical education component. For the past 20 years, theUniversity ofIllinois College Of Medicine atRockford has successfully recruited, produced and retained rural physicians forIllinois through the Rural Medical Education (RMED) Program. Historically, this campus has housed a medical school; five years ago the Illinois Board of Higher Education approved the interdisciplinary-focusedNationalCenter for Rural Health Professions (NCRHP). The site is now designated a “health sciences education” campus of theUniversity ofIllinois. Description of Intervention or Program: The RHP Program was developed over five years. The Rural Pharmacy Education (RPHARM) Program was created to move the NCRHP mission forward. The single discipline RMED Program was expanded and became the interdisciplinary RHP Program (RMED and RPHARM students). Planning is underway to include disciplines such as nursing, social work, public health and dentistry. All students enrolled in the program completed an orientation survey to obtain perspectives and background demographics. Results: A formal recruitment and admissions process and a curriculum based on the longstanding RMED curriculum were developed; an assessment strategy was also created. Twenty-two students and 26 students were accepted into the RHP Program for the classes 2014 and 2015. Approximately 90% of RHP students were from rural areas. Conclusions: Student responses to baseline surveys indicate a positive orientation toward rural community health and participation in a curriculum teaching these principles. The RHP Program is a promising interprofessional approach to preparing healthcare providers who will locate or stay in rural areas. Relevance to interprofessional education or practice: Beneficial for interprofessional rural education: recruitment, retention and practice of professionals. Learning Objectives: To compare and contrast various programs and activities within an interprofessional rural healthcare program To describe how to recruit students into an interprofessional rural healthcare program To recall current students’ perspectives on rural healthcare and the RHP progra